Patient Emergency Response System

ABSTRACT

An improved emergency response system is provided. The system includes a patient or subscriber location database having a schedule of patient or subscriber activities. In one implementation, an emergency services server detects when the patient or subscriber is having a possible medical event as indicated by medical physiologic data transmitted from a wireless communication device proximate the patient. A third party such as a technologist and/or doctor diagnoses the patient and determines whether treatment is required. If treatment is required, a phone located remotely from the patient is used to call an emergency services first responder from a public safety access point in the patient&#39;s location. The remotely located phone has an automatic location identification database record that is updated based on the patient&#39;s current location as indicate by the patient location database. The address information in the patient location database includes street number, building number, floor and room number information, if applicable, to ensure that first responders are directed to the patient&#39;s specific location. Other implementations of the emergency response system are also described, including natural disasters, home security, and travel applications.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 61/423,484, filed on Dec. 15, 2010, the entirety ofwhich is hereby incorporated by reference.

FIELD

This disclosure relates to emergency response systems, and moreparticularly, to emergency response systems with improved methods fordispatching emergency services personnel to a specific location at whicha patient or subscriber is located.

BACKGROUND

As health care costs continue to rise, it becomes increasingly desirableto minimize the length of time patients must be hospitalized while stillensuring that they receive the appropriate degree of care. Many standardtreatment protocols require patients to undergo continual testing andmonitoring that may diagnose medical problems and emergencies. Forexample, many patients with heart problems require stress testing andmonitoring. However, to reduce costs, it is desirable to conduct suchtesting and monitoring in facilities that lack physicians or equipmentto perform emergency medical services should the patient experience amedical event, such as a heart attack or stroke. Such testing could beperformed in hospitals, however, doing so reduces the number of suitabletesting facilities and requires increased patient travel. In addition,outside of hospital facilities many of the personnel who perform suchoutpatient testing lack the diagnostic skills to determine if a patientis experiencing a medical event requiring treatment and may not bepresent with the patient when an event occurs. Thus, a remotely locatedtechnologist and/or physician is required to determine whether thepatient needs treatment, and if so, identify a suitable treatmentfacility.

In one scenario, it would be desirable to provide patients withphysiologic testing devices that monitor their condition and which alertmedical personnel to a possible medical event. Some devices that arecapable of wirelessly transmitting patient physiologic data to a remoteserver, such as via the internet, exist. However, even though the servermay be programmed to determine if such data is indicative of a medicalevent, there is no reliable way for remote medical personnel to select asuitable treatment facility and contact the public safety access point(PSAP) in the patient's geographic location to dispatch first respondersto the patient's specific location. In addition, if the patient isunconscious or unable to communicate, his or her geographic location maybe difficult to ascertain. In certain situations, a cellular telephonein the patient's possession or near the patient may be used to determinethe patient's location for purposes of dispatching medical personnel.However, such devices are typically accurate to within 300 meters, alevel of accuracy which is typically not sufficiently reliable to ensurethat first responders can quickly locate the patient. Thus, a need hasarisen for an improved patient emergency response system.

SUMMARY

In accordance with a first aspect, a system for providing emergencyservices to a patient is provided which comprises a phone locatedremotely from the patient and an emergency services server programmed togenerate an updated automatic location identification database recordfor the phone based on the patient's location. In certain embodiments,the phone is a VoIP (voice over internet protocol) phone. In otherembodiments, the emergency services server is programmed to generate amaster street address guide address for the patient's location, and theupdated automatic location identification database record includes themaster street address guide address.

In additional embodiments, the emergency services sever is programmed todetermine the patient's location based on a time stamp. In furtherembodiments, the emergency services server is programmed to determinethe patient's location by comparing the patient time-stamp to aplurality of database time entries corresponding to the patient anddetermining whether any of the plurality of database time entriescorresponding to the patient are within a pre-selected time incrementfrom the patient time-stamp. In still other embodiments, the patienttime-stamp corresponds to one selected from radiolocation coordinatesand global positioning system coordinates transmitted by a wirelesscommunication device proximate the patient. In yet other embodiments,the system further comprises a patient location database comprising aplurality of database time entries and a plurality of database patientlocations, wherein each of the database time entries corresponds to apatient, and each database patient location corresponds to a databasepatient time entry.

In other embodiments, the system further comprises a treatment facilitydatabase including a plurality of database treatment facilities, anddatabase treatment facility locations, database treatment facilityservices, and database treatment facility schedules corresponding toeach of the database treatment facilities. In another aspect, a systemfor providing emergency medical services is provided which comprises aphone having an associated automatic location identification databaserecord, wherein the automatic location identification record containslocation information for the phone. The system also comprises a patientlocation database, comprising database patient identity information fora plurality of patients and one or more database patient locations foreach patient from among the plurality of patients. The system furtherincludes an emergency services server programmed to determine a patientlocation based on preliminary patient location information, databasepatient identity information, and the one or - more database patientlocations corresponding to the patient, wherein the emergency servicessever generates an updated automatic location identification databaserecord for the phone based on the determined patient location or auser-entered patient location. In certain embodiments, the emergencyservices server is programmed to generate a master street address guideaddress for the patient's location, and the updated automatic locationinformation database record includes the master street address guideaddress.

In an additional aspect, a method of providing improved emergencyservices is provided. The method comprises receiving a patient's medicalphysiologic data indicating the occurrence of a medical event,determining the patient's location, and updating an automatic locationidentification database record for a phone based on the patient'slocation, wherein the phone is located remotely from the patient. Incertain embodiments, the method further comprises entering apredetermined emergency services number into the phone, thereby placinga call to a public safety access point corresponding to the updatedautomatic location identification database record. In other embodiments,the step of determining the patient's location comprises determining thepatient's location based on a patient time-stamp corresponding to oneselected from radiolocation coordinates and global positioning systemcoordinates. In additional embodiments, the step of determining thepatient's location comprises determining if the patient's time stamp iswithin a pre-selected time increment from a database time entrycorresponding to the patient. In other embodiments, the method comprisesselecting a treatment facility based on at least one selected from thegroup consisting of the patient's location, facility locationinformation, the patient's medical condition, and a time-stampcorresponding to one selected from radiolocation coordinates and globalpositioning system coordinates.

In yet another aspect, a method of determining a patient's location isprovided. The method comprises providing a patient time-stamp, providinga schedule of patient activities, wherein the schedule comprises aplurality of scheduled times, each time corresponds to a scheduledlocation, and each scheduled location comprises a master street addressguide location, and receiving a preliminary location for the patient.The method further comprises selecting a scheduled location based on thetime-stamp and the preliminary location. In certain embodiments, thestep of selecting a scheduled location based on the time-stamp andpreliminary location comprises selecting a first scheduled time, thefirst scheduled time is within a selected time increment from thetime-stamp, and the first scheduled time corresponds to a firstscheduled location. In other embodiments, the first scheduled locationis within a selected distance from the preliminary location. In otherembodiments, the selected distance is no greater than about 600 meters.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring now to the drawings, illustrative embodiments are shown indetail. Although the drawings represent some embodiments, the drawingsare not necessarily to scale and certain features may be exaggerated,removed, or partially sectioned to bend illustrate and explain thepresent invention. Further, the embodiments set forth herein areexemplary and are not intended to be exhaustive or otherwise limit orrestrict the claims to the precise forms and configurations shown in thedrawings and disclosed in the following detailed description.

FIG. 1A is a depiction of a first embodiment of an improved system forproviding emergency services;

FIG. 1B is a depiction of a second embodiment of an improved system forproviding emergency services;

FIG. 1C is a depiction of a third embodiment of an improved system forproviding emergency services;

FIG. 2 is a depiction of database records from a patient locationdatabase;

FIG. 3 is a depiction of database records from a treatment facilitydatabase;

FIG. 4 is a flow chart used to illustrate a first embodiment of a methodof determining a patient or subscriber's location;

FIG. 5 is a flow chart used to illustrate a second embodiment of amethod of determining a patient or subscriber's location;

FIG. 6 is a flow chart used to illustrate an embodiment of a method ofproviding emergency services to a patient or subscriber;

FIG. 7 is a flow chart used to illustrate a method of selecting atreatment facility for a patient experiencing a medical event; and

FIG. 8 is a flow chart used to illustrate a method of providingemergency services to a patient being transferred from one location toanother.

DETAILED DESCRIPTION

Referring to FIG. 1A, a system 20 for providing emergency services to apatient with a medical condition is provided. System 20 comprises one ormore physiological data devices 30 used to make various physiologicalmeasurements of the patient, an emergency services server farm 61, acall center 54, an automatic location identification (“ALI”) system 48,a public safety answering point or “PSAP” 40, a Private Branch Exchangeor “PBX” 64, and a selective routing switch 66. System 20 also includesa computer network 34, which is preferably a wide area network (“WAN”)and even more preferably the internet. As discussed in greater detailbelow, system 20 allows a technologist located in call center 54 to makean emergency services call to obtain emergency services for the patient.The call will generally be made using an emergency services number suchas 9-1-1 (U.S.), 9-9-9 (U.K.), 1-1-2 (Germany, Denmark, Iceland,Sweden). In some jurisdictions, there are multiple emergency servicesnumbers depending on the nature of the requested emergency services(police, ambulance, or fire).

In certain implementations, the technologist will make an emergencyservices call from call center phone 56, and the call will be routed tothe PSAP 40 responsible for the jurisdiction in which the patient, notthe call center 54, is located. In additional implementations, the PSAP40 will receive data indicating the patient's location by querying anALI database 48 record associated with the call center phone 56. Inother implementations, information transmitted from the patient to thetechnologist in call center 54 will be “geocoded” to provide anaddress—such as a full MSAG (master street address guide) address—whichis more accurate than those provided by many current systems. The callcenter phone may be a landline, VoIP phone, or a cell phone, but ispreferably a landline or VoIP phone.

PSAP 40 dispatches the necessary emergency responders (fire, police,ambulance) to the patient in response to a voice call, and in someexamples, in response to patient location data related to the voicecall. A PSAP will typically include several PSAP operators each with aterminal 44 and a phone 42. Only one phone 42 and terminal 44 are shownin FIG. 1A. A PSAP 40 will typically also include at least one PSAPserver 46 to facilitate the transmission, receipt, and storage of datarelated to emergency calls.

ALI system 48 comprises one or more servers 50 and one or more databases52. The ALI system stores location information for emergency servicescallers and provides it to PSAP 40 to better enable the PSAP 40 todispatch the necessary emergency responders to the correct location,especially where the caller cannot communicate with the PSAP (e.g., dueto unconsciousness). In typical known systems, the PSAP 40 receives avoice call and a telephone number associated with the call known as an“ANI” or “Automatic Number Information” value. In certainimplementations, in particular those used for wireless and/or VoIPcalls, the ANI is referred to as a “pseudo-ANI” or “p-ANI.” The p-ANI isa string of digits, such as the ten digits in a phone number, which maybe used to encode the caller's location, as may be indicated by a celltower and sector or latitude/longitude. As used herein, the term “ANI”refers to a standard ANI (telephone number) or a p-ANI.

In certain jurisdictions which use enhanced 9-1-1 systems, when the PSAPreceives an emergency services call, it then transmits the ANI back tothe ALI system 48 and requests the caller's location (a processsometimes called “bidding” or “dipping”). The ALI system database 52includes fields that correspond ANI or p-ANI values to a physicallocation (e.g., street address, city, state). An ALI data record for thecaller is then transmitted back to the PSAP terminal 44 via PSAP server46 to better enable the PSAP to dispatch emergency services to thelocation identified by the ALI record. In jurisdictions with older 9-1-1systems, ALI system 48 may not exist, and ALI records may not beprovided to the PSAP 40.

System 20 is particularly useful for patients who must be closelymonitored and routinely tested due to a known medical condition, such ascardiac disease, diabetes, etc. The range of medical conditions forwhich system 20 may be used is not limited. In one implementation, apatient subscribes to use system 20 and is associated with one or morecall centers 54 used to monitor the patient's after care following hisor her release from a medical facility. Call center 54 is staffed withone or more technologists who monitor the subscribing patients' medicalconditions by tracking physiological data transmitted from the patientto the call center 54 via computer network 34. Call center 54 maycomprise a single building or a plurality of buildings, which may beco-located or geographically disperse. The technologists in call center54 receive information concerning potential medical events beingexperienced by the patients they serve and diagnose the patient'scondition based on the received data and/or based on communications withthe patient. The technologists may also enlist the aid of a physician orother third party to provide diagnostic assistance. Based on the resultsof such diagnoses, the technologist may contact PSAP 40 to dispatchemergency responders to the patient's location to provide needed medicalattention and/or transport the patient to a treatment facility 31 wheresuch attention can be provided. System 20 may be used with a widevariety of medical events and is not limited to any particular event orevents. Non-limiting examples of such events include acute coronarysyndrome, myocardial ischemia, myocardial infarction, cardiacarrhythmia, syncope, congestive heart failure, pulmonary edema, stroke,transient ischemic attack, elevated intracranial pressure, seizure, andcarbon monoxide poisoning.

In system 20, one or more physiological data devices 30 are providedwhich detect physiological data for a patient and transmit the data to acommunication device 32 via either wireless or wired connections.Communication device 32 then transmits the physiological data totechnologist terminal 58, server farm 61, physician communication device36, and/or treatment facility terminal 33 via computer network 34. Avariety of known physiological data devices 30 may be used to measurephysiological data such as ECG data, implantable cardioverterdefibrillator data, blood vessel impedance data, intra-cardiac pressuresensor data, ultrasound data, intracranial pressure sensor data, pulseoximetry data, co-oximeter sensor data, light absorbance data,glucometer data, EEG data, and endovascular graph sensor data, to name afew. Suitable physiological data devices 30 configured to transmit datato communication device 32 include those supplied by Card GuardScientific Survival, Ltd., of Rehovot, Israel and QRS Diagnostic ofMaple Grove, Minn. Other suppliers of such physiological data devicesinclude Nasiff Associates, Inc. of Central Square, New York and PulseBiomedical, Inc. of Norristown, Pa. For wireless implementations, thephysiological data devices 30 will preferably include a wirelesstransmitter configured to wirelessly transmit data to patientcommunication device 32. Wireless communications between physiologicaldata devices 30 and patient communication device 32 may be providedusing various protocols and other wireless technologies, including 3Gand 4G wireless technologies and the IEEE series of wirelesstechnologies. More particularly, wireless communications may take placeover a CDMA, EDGE, EV-DO, GPRS, GSM, UMTS, W-CDMA, or a 1xRTT network aswell as an IEEE 802.11 (WiFi), 802.15 (Bluetooth and Zigbee), 802.16(WiMax) or 802.20 (MBWA) network.

Patient communication device 32 acts as a gateway to computer network34. Suitable communication devices 32 will be capable of wirelesslycommunicating with one or more internet servers, in particular,emergency services servers 60, located in emergency services server farm61. Suitable communication devices 32 include wireless transmitters andinclude cellular telephones, smart phones, tablet computers, laptopcomputers, desktop computers with wireless modems, etc.

In cases where wireless transmission between patient communicationdevice 32 and computer network 34 cannot be achieved or istransient—such as in the case of the patient living in the basement orout of wireless range—an additional device, such as a wireless router,can be integrated to send the data via wired transmission to internetcloud 34. One such exemplary router is the GAC 150 WiFi dial up routersupplied by Great Arbor Communications of Potomac, Md. In such cases,the patient plugs the router into a phone jack or an existing Ethernetport. When the reception is weak the patient communication device willswitch to WiFi and look for the router signal. If the router isconnected to an Ethernet port, it will transfer the data through thepatient's own wired internet connection (e.g., home broadband cable orDSL connection). If the router is connected to the phone line, when therouter senses a WiFi connection from the phone, it automatically dialsthe “dial up services” to get a 54K dial up connection.

In other cases, a patient may live in a rural area without phone orinternet service. In . such cases, the patient is provided with awireless network extender that connects to patient communication device32 via WiFi and is able to transmit data and voice over satellite. Inthis scenario, the patient communication device 32 preferably has adirect line of sight to the sky (i.e., a window).

Technologist terminal 58 is configured to communicate with server farm61 via computer network 34 and to receive patient physiological datatherefrom. Terminal 58 may include a processor and one or more storedprograms for performing various types of displays and/or analyses ofretrieved physiological data as well as for retrieving patientinformation, such as patient identity information, patient locationinformation, patient schedule information, patient medical historyinformation, patient medications, etc.

ALI system 48 is generally a known type of ALI system used in enhanced9-1-1 systems and is configured to provide an address data record toPSAP 40 based on an ANI or p-ANI value received from the PSAP 40. TheALI may serve a large geographic area and will not generally be limitedto those patients served by call center(s) 54. The specificity of theaddress information contained in any particular ALI record may vary andmay include a street name, street number, city name, and state name. TheALI record may also include cell phone radiolocation coordinates (a celltower site and sector) and global positioning system coordinates (e.g.,a longitude and latitude). In certain implementations described herein,ALI records may be supplemented to include further specific patientlocation information such as a building number (e.g., an internaladdress within a complex of buildings), a floor number, and a roomnumber. In certain jurisdictions a “master street address guide” or“MSAG” may exist which is an official record of valid streets,thoroughfares, house numbers and communities in the jurisdiction, andthe ALI database 52 records may include MSAG addresses. In otherimplementations involving next generation 911 (NG911) systems, the ALIrecord may be further supplemented to include video, voice, pictures,floorplans, and medical information data.

Call center 54 is connected to PSAP 40 via PBX 64 and selective routingswitch 66. PBX 64 is a private telephone network used within anenterprise or company, and its users share outside lines for makingtelephone calls external to the PBX 64. Selective routing switch 66 andALI System 48 are typically operated by an emergency servicesprovisioning provider. PBX 64 determines whether a particular voice callis an emergency services call or a non-emergency services call. If thecall is an emergency services call, the selective routing switch 66routes the call to a selected PSAP 40, which is preferably the PSAP 40servicing the jurisdiction in which the patient is located at the timethe patient experiences a potential medical event. Selective routingswitch 66 utilizes a selective routing database (SRDB) (not shown) toroute the call to the PSAP servicing the location defined by the ALIinformation.

Certain known SRDBs for landline applications use the ANI associatedwith an emergency call (i.e., the telephone number from which the callis made) to determine the correct PSAP to which the call should berouted. In certain existing applications for landline emergency callers,the ANI is uniquely associated with the caller's address in the ALIdatabase 52 and the ANI can be used to properly route the emergencycall. However, in certain implementations of system 20, call centerphone 56 will be used to place the emergency services call, despitebeing located remotely from the patient. In known systems, the use ofthe call center phone 56 ANI to route the call would cause the call tobe routed to the PSAP in the jurisdiction in which the call center 54 islocated, instead of that in which the patient is located.

In one implementation of system 20, the SRDB (not shown) correlates ANIand p-ANI values to PSAPs. In this implementation, the correlationbetween ANI/p-ANI and PSAP is dynamically updated based on the locationof the patient so that a call from phone 56 is routed to the PSAP 40 inthe same jurisdiction as that location. In this manner, callsoriginating from call center phone 56 will appear to the PSAP to haveoriginated from the patient's location instead of the call center 54location. When a technologist in call center 54 determines thatemergency services should be dispatched to a patient, the patient'scurrent location may also be used to create an updated ALI record forcall center phone 56.

In another implementation of system 20, “location-based” routing isused. In this implementation, the SRDB (not shown) correlates ALIlocations to PSAPs. In certain examples, the PSAPs geographic boundariesare used to determine which PSAP is responsible for the caller'slocation. Thus, once the ALI record for the call center phone 56 isupdated based on the patient's location, the SRDB (not shown) uses thatupdated ALI record to select the appropriate PSAP 40. The selectiverouting switch 66 then routes the call to the selected PSAP 40. In thisimplementation, there is no-need for a database that correlates ANIvalues to PSAPs. The SRDB (not shown) does not need to be dynamicallyupdated based on the caller's location because the PSAPs geographicboundaries are static (with the exception of infrequent changes made bythe government). However, regardless of whether ANI-based routing orlocation-based routing is used, selective routing switch 66 effectivelyuses the patient's location to route the call placed by call centerphone 56 to a PSAP 40 responsible for the patient's location.

System 20 is particularly useful for situations in which the patient isunable to make an emergency services call or is unable to access alandline with a fixed ANI and ALI record. Cell phones and VoIP phones donot have fixed locations, and thus do not have fixed ALI records orfixed associations between a PSAP and an ANL Known methods for routingemergency services calls placed from cellular telephones exist. However,the location information transmitted from a cellular telephone, such asGPS coordinates or radiolocation coordinates, is generally only accurateto within +/−300 meters, a level of accuracy which may make itimpossible for emergency responders to locate the patient or at least tolocate the patient quickly enough to provide the necessary medicaltreatment. Accordingly, in system 20, the technologist uses call centerphone 56 to place the emergency services call for the patient. Emergencyservices database 62 includes location information for the patient whichis preferably more accurate than that provided by global positioningsystem or radiolocation coordinates. This location information is usedto update the ALI record for call center phone 56 and transmit theupdated record to ALI system server 50, which then updates ALI database52 with the patient's current location. The SRDB (not shown) uses theupdated patient location information to determine the PSAP 40 to whichthe call will be routed. As indicated previously, this may involveupdating a table that correlates ANIs to PSAPs (ANI-based routing) or itmay involve using the updated ALI record to determine which PSAP'sgeographic boundaries encompass it (location-based routing). In thosejurisdictions in which an ALI database is available, the PSAP 40 thenqueries the ALI system 48 with the call center phone's 56 ANI. Based onthe ANI, the ALI server 50 queries the ALI database 52 to obtain thelocation record associated with the ANI (a process known as “bidding” or“dipping”) and transmits it to PSAP 40 for display on the PSAP terminal44, thereby allowing the PSAP operator to dispatch emergency respondersto the correct patient location. In certain implementations, selectiverouting switch 66 may comprise a sever capable of transmitting data andvoice signals to PSAP 40, and the ALI record may be transmitted with thecall, thus eliminating the need for a subsequent ALI database 52 query.

Certain existing selective routing systems may be used to update an ALIrecord and correctly route an emergency services call based on thelocation information retrieved from the emergency services database 62(i.e., location-based routing). One system is provided by Dash CarrierServices and is referred to as a “Dynamic Geospatial Routing” system. Inone example, the selective routing switch 66 uses a map database whichcorrelates PSAPs and their telephone numbers to geographic locations.The map database may be part of the SRDB (not shown) and can be usedwith the patient location information provided by the emergency servicesserver 60 to identify the correct PSAP 40 to which selective routingswitch 66 will route the call.

As indicated in FIG. 1A, the call center technologist may alsocommunicate with a physician's smart phone 36 by providing data from theemergency services server 62 to it. In addition, system 20 may beconfigured to allow the physician to directly access a patient's datafrom emergency services server 62. This allows the technologist toconsult with a physician about the patient's condition and obtaindiagnostic and/or treatment advice from the physician. In some cases,however, the technologist may have sufficient information to make adiagnosis or determine that emergency responders should be dispatched tothe patient without consulting with a physician.

In certain implementations of system 20, one or more treatment facilityterminals 33 for one or more treatment facilities 31 are also connectedto network 34, allowing the technologist to communicate data about apatient and/or a medical event to the treatment facility to aid indetermining if the facility has the necessary staff and facilities toaddress the patient's medical event.

Referring to FIG. 1B, an alternate embodiment of a system 22 forproviding emergency patient services is provided. System 22 isconfigured similarly to system 20, and like components are identifiedwith like numerals. However, in system 22 no separate call center 54 ortechnologists are provided. Instead, certain PSAPs are designated as“participating PSAPs” 70 and perform the same function as the callcenter 54 and technologists of system 20 in FIG. 1A. The participatingPSAPs 70 receive patient physiological data transmitted fromphysiological data devices 30 and function in the same manner as thecall center 54 technologists of FIG. 1A. If a participating PSAP 70 isalerted to a medical event for a patient in its jurisdiction, it canaccess patient location data from emergency services server farm 61 anddispatch the emergency responders to the correct location. However, ifthe Participating PSAP 70 is not in the same jurisdiction as thepatient, it can then transmit patient location information retrievedfrom the emergency services server 62 to the ALI system 48 and cause theALI record for the PSAP 70 phone to be updated based on the patient'slocation. The participating PSAP 70 operator can then dial the emergencyservices number from participating PSAP phone 72, causing the selectiverouting switch 66 to route the call to the Non-Participating PSAP 40servicing the patient's location. The Non-Participating PSAP 40 thenqueries the ALI database to obtain the ALI record for phone 72, whichcorresponds to the patient's location, not that of phone 72. Based onthis information, the Non-Participating PSAP 40 can dispatch emergencyresponders to the patient's location.

Another embodiment of a system 24 for providing emergency patientservices is depicted in FIG. IC. In this embodiment, call center 54 isnot used. Instead, emergency services calls are placed by the physicianusing physician's communication device 36, which is preferably a smartphone. Physician's communication device 36 is connected (wirelessly) toPBX 64. Physician's communication device 36 is programmed to transmit anupdated ALI record for device 36 to ALI system 50 so that the ALI recordassociated with physician's communication device 36 corresponds to thepatient's location. Selective routing switch 66 routes the call based onthe updated ALI record to the PSAP servicing the patient's location.

As indicated above, systems 20, 22, and 24 allow an emergency servicescall placed from a phone 56, 72, 36 (respectively) which is locatedremotely from a patient to be routed to the PSAP responsible for thepatient's jurisdiction, rather than the jurisdiction in which the phone56, 72, 36 is physically located. As described below, in certainimplementations, the patient's location is “geocoded” or linked tocertain information transmitted from the patient, such as a time-stamptransmitted from the patient's communication device 32.

Emergency services server farm 61 includes one or more emergencyservices databases 62. Emergency services databases 62 may include avariety of different databases related to providing emergency services.Depicted in FIG. 2 is a patient location database 80 used in thegeocoding of patient locations. Patient location database 80 includes aplurality of records 82 a-82 f and a plurality of fields 84 a-84 j foreach record. In the example of FIG. 2, patient location database 80includes schedule information for one or more patients, although onlyone patient (John Doe) is used to illustrate the database 80. Eachpatient's records (82 a-82 g) define a scheduled event in the dailyactivities of the patient. Thus, field 84 a provides the name of thepatient. Field 84 b provides the date (or day of the week) of ascheduled activity. Field 84 c provides the time of a scheduledactivity. Fields 84 d-84 i collectively define a patient location for ascheduled activity. In certain preferred embodiments, fields 84 d-84 icollectively define the Master Street Address Guide (MSAG) address atwhich the scheduled activity takes place. In the example of FIG. 2,field 84 d includes a street number, field 84 e includes a street name,field 84 f provides a building number (as in the case of amulti-building complex), and field 84 g provides a floor number. Fields84 h and 84 i respectively include the city and state of the scheduledevent. If appropriate, other patient location fields may be included.For example, in some implementations, the patient may be in a largebuilding with a number of rooms or offices, and a field for the numberof the room or office in which the scheduled event takes place may alsobe included. Other fields which may be provided include the phone numberof the location, a contact person and company associated with thescheduled event, the duration of the scheduled event with a variance(e.g., +/−5 mins), a variance for the scheduled time, and the date thescheduled time (or other information in a given record) was lastupdated. As illustrated in records 82 a, 82 c, 82 d, and 82 f, in somesituations the event will be a transfer of the patient from one locationto another. Transfers may also include other fields specific totransfers such as route data and the transit company.

Field 84 j provides information about the nature of the scheduled eventor appointment. In the example of FIG. 2, the scheduled events includecardiologist appointments and ECG test appointments, as well as transitevents to and from those appointments. In certain implementations,patient location database 80 is used with patients who have beenrecently discharged from a medical facility and who undergo routinetesting to monitor their condition. Such patients may undergo testingwhich itself can lead to the occurrence of a medical event. Much of thistesting may occur outside of medical facilities that can provideemergency medical care, and as a result, system 20 (or 22) may be usedto dispatch emergency responders to the patient's testing location, ifnecessary.

For example, patients who suffer from cardiac disease may undergoscheduled stress tests at regular intervals, which could cause a medicalevent such as a myocardial infarction to occur. With rising medical carecosts, it is desirable to treat and monitor patients outside of ahospital setting. However, this approach presents the risk that thepatient will undergo a medical event which requires emergent care. Insuch cases, it is beneficial to have a well-defined patient location inthe patient location database 80 so that emergency responders canquickly respond to the emergency. Systems 20, 22, and 24 can be used toimprove emergency responder response times and better ensure that thepatient is quickly located and transported to an appropriate treatmentfacility 31 tailored to the patient's medical event. Patient locationdatabase 80 allows technologists in call center 54 (or participatingPSAPs 70) to determine the patient's location and route an emergencycall to the correct PSAP with a level of accuracy that would not beavailable unless the patient placed the emergency services call from alandline, something that may not be possible during an emergency event.For example, if the patient were to call 9-1-1 from a cellulartelephone, the call would be routed (and the ALI record for the phone 56would be updated) based on the patient's global positioning systemcoordinates or radiolocation coordinates. These location identificationtechniques are known to be accurate to a level of no greater than 300meters. Even when landlines are used, the patient may be at an internallocation in a large building or complex which is not specificallyidentified in the ALI database. As a result, emergency responders maynot be able to find the patient in time to transport him or her to theappropriate treatment facility. As will be discussed further below, incertain embodiments systems 20 and 22 are configured to so that during amedical event the technologist or participating PSAP receives thegeocoded address from fields 84d-84i in the patient location database80. The technologist then causes the emergency services server 60 totransmit that information to the ALI system 48 to update the ALI recordfor the call center phone 56 (or participating PSAP phone 72) with thepatient's geocoded address. The selective routing switch 66 uses theupdated ALI record to route the call to the PSAP responsible for thepatient's location (as indicated by the geocoded address). Systems fordynamically updating ALI records are commercially available, and includethose provided by suppliers such as Intrado, RedSky, Dash CS, and 8×8,Inc.

In certain implementations, the emergency services database(s) 62include a treatment facility database 90. An exemplary depiction of atreatment facility database 90 is provided in FIG. 3. Treatment facilitydatabase 90 includes information that enables the technologist orparticipating PSAP 70 to identify and select treatment facilities towhich a patient should be transported in the case of a medical event.The process of identifying a correct treatment facility may be based ona number of factors, some of which may include the treatment facility'slocation, the treatment facility's equipment and capabilities, the timeof the day, and the availability of certain treatment facility staff.Treatment facility database 90 includes a plurality of records 92 a-92 ceach of which corresponds to particular treatment facilities. Treatmentfacility database 90 also includes a plurality of fields 94 a-94 i whichinclude a variety of information about each treatment facility. Forexample, in FIG. 3, fields describing the name of the treatment facility94 a and treatment facility location (fields 94 b-94 g) are provided.The treatment facility location information in fields 94 b-94 g maycorrespond to the facility's MSAG address in certain implementations. Inthe specific example of FIG. 3, the treatment facility locationinformation in treatment facility database 90 includes a street number94 b, street name 94 c, city 94 d, state 94 e, building 94 f (as in thecase of a multi-building complex), and floor 94 g. Although notillustrated in FIG. 3, a given medical building or complex may haveseveral internal treatment facilities. Separate records may be providedfor each distinct internal facility to better ensure that the patient isrouted to the correct internal location. For example, a given hospitalmay have a surgery wing and a cardiac catheterization lab, which may besome distance from one another within the hospital. In that case,treatment facility database 90 may include two records for the hospital,one of which pertains to the surgery wing and another which pertains tothe cardiac catheterization lab. Additional fields may also be providedwhich include some or all of the following: treatment center phonenumbers, treatment center fax numbers, treatment center e-mailaddresses, on-call physician pager numbers and e-mail addresses, FTPlinks for transmitting medical data to/from the treatment center, and adate/time when information was last updated.

In certain examples, emergency services server 60 (which may comprises aplurality of servers) is programmed to identify a patient location basedon the information included in patient location database 80, forexample, by performing a database query operation of patient locationdatabase 80. In certain cases, the technologist initiates the query fromcall center terminal 58. FIG. 4 illustrates an exemplary method that maybe used by emergency services server 60 to perform the query operation.As illustrated in the figure, in step 1002 the emergency services server60 receives a time-stamp, i.e., data indicative of a date, day of theweek, and/or time of day. The emergency services server 60 also receivesa preliminary location information for the patient. In certain examples,the preliminary location information will include global positioningsystem coordinates or radiolocation coordinates for the patient'scommunication device 32. Based on the time-stamp and the preliminarylocation information, the program executed by emergency services server60 will obtain a scheduled location from patient location database 80.In some circumstances, the preliminary location information may not beavailable, in which case the program will select a scheduled locationfor the patient based on the time-stamp only. In other circumstances,the time stamp may be the time that the emergency services server 60receives an alarm or other indication that a medical event may beoccurring, as opposed to a time-stamp received directly from a patientcommunication device 32.

A variety of methods may be used to select a patient location from thepatient location database 80 based on a time-stamp and preliminarylocation information. Once such method is depicted in FIG. 5. Inaccordance with the method, in step 1008 a first scheduled location isselected from a schedule of patient activities by selecting a firstscheduled time that is within a pre-selected time increment of thepatient time-stamp. Referring to the exemplary patient location databaseof FIG. 2, a time-stamp corresponding to 1:45 pm on Sep. 19, 2010 iswithin a 30 minute time increment of both the event identified in record82 a (transit from home to cardiologist) and the event identified inrecord 82 b (cardiologist appointment). At 1:45 pm, the patient maystill be in transit to the cardiologist or he or she may have arrived atthe cardiologist's office.

Using the patient's preliminary location information (e.g., GPS orradiolocation coordinates), in step 1010 a distance d₁ is calculatedfrom the preliminary location to the first scheduled location. In oneembodiment, a straight line distance between the two locations iscalculated. The distance d₁ is preferably less than about 600 m, morepreferably less than about 300 m, more preferably less than about 100 m,and even more preferably less than about 30 m. In step 1012, it isdetermined whether the calculated distance d₁ is less (or no greater)than a selected distance. This step is used to determine whether thefirst scheduled location is likely where the patient actually is. If d₁indicates that the patient is likely to be in the first scheduledlocation, in step 1016 the ALI record for the call center phone 56 isupdated to match the location information for the first scheduled event.In ANI-based routing solutions, the PSAP responsible for the location inwhich the first scheduled event occurs is associated with the ANI forthe call center phone 56 in the SRDB (not shown) so that the selectiverouting switch 66 will route the call to that PSAP. Step 1016 may beimplemented in a number of different ways. In one implementation, thelocation information for the first scheduled event is transmitted totechnologist terminal 58 to allow the technologist to determine whetherthe location is believed to be reliable. The technologist can then useterminal 58 to initiate transmission of the location information to ALIserver 50 for storage in the ALI database 52. This will cause emergencyservices calls placed from phone 56 to be routed to the PSAP servicingthe patient's geocoded location. The PSAP 40 will then query the ALIsystem 48 for the address corresponding to call center phone 56, and ALIsystem 48 will transmit the patient's scheduled event location to thePSAP terminal 44.

In step 1012, if the calculated distance d₁ is greater (or no less than)the selected distance, in step 1014, a second scheduled location isselected which also has a scheduled time within the preselected timeincrement of the patient time-stamp (if such a scheduled event exists).In step 1018, the distance d₁ is calculated between the second scheduledlocation and the patient's preliminary location. If d₁ is less than (orno greater than) the selected distance, control proceeds to step 1022,causing the ALI record for the call center phone 56 to be updated to thesecond scheduled location specified in the patient location database 80as with step 1016. In step 1020, if d₁ is greater than (or not lessthan) the selected distance, control is transferred to step 1024 and anunscheduled location is selected which is closest to the preliminarylocation.

Although not depicted in FIG. 2, the patient location database 80 mayinclude a variety of known locations at which a patient may be presentat any given time, although the locations are not associated with anyparticular scheduled event. In step 1024, the program calculates thedistance between the patient's preliminary location and each unscheduledlocation, and the unscheduled location which is the closest to thepatient's preliminary location is selected. In step 1026, the ALI recordfor call center phone 56 is updated to match the unscheduled location.In ANI-based routing solutions, the PSAP 40 responsible for theunscheduled location is associated with the ANI for the call centerphone 56 in the SRDB (not shown). In certain implementations, theunscheduled locations are MSAG addresses. Unscheduled locations mayinclude places such as relative's/friend's residences, supermarkets,banks, post offices, restaurants, bars, theaters, sporting arenas, orany other locations the patient is known to frequent. If no unscheduledlocation corresponds to the time-stamp received by emergency servicesserver 60, the patient's preliminary location information (e.g., GPS orradiolocation coordinates) is used as the patient's geocoded location.The AM for the call center phone is then associated with the PSAPresponsible for that geocoded location, and the ALI record associatedwith the ANI is updated to the geocoded location.

In certain implementations, it may be desirable to have the call center54 technologist confirm the patient's location during a suspectedmedical event to ensure that location information obtained from thepatient location database 80 is accurate. If the patient's locationdiffers from that predicted by the patient location database 80, thetechnologist may use the confirmed location to update the ALI record forthe call center phone 56. It may also be desirable to include a processfor selecting a treatment facility 31 that is best able to handle thepatient's medical event. An exemplary method that includes thesefeatures is described in FIG. 6. In step 1028, the technologist receivesa preliminary indication of a medical event from the patient. Asdiscussed previously, in one example, the indication may be provided bya message or alarm generated by emergency services server 61 andtransmitted to technologist terminal 58. The alarm or message may bebased on values of physiological data generated by physiological datadevices 30 and transmitted from patient communication device 30 toemergency services server 60. In step 1030, the ALI database 52 recordfor the call center phone 56 (or participating PSAP phone 72) is updatedbased on a predicted patient location obtained from the patient locationdatabase 80. One exemplary method for carrying out step 1030 is themethod described in FIG. 5.

In step 1032, the technologist uses the call center phone 56 to contactthe patient on his or her communication device 32. In addition, thetechnologist may use other forms of communication such as e-mail andtext messages, depending on the particular communication device 32 usedby the patient. The technologist then asks the patient to confirm his orher location. If the patient is unconscious or otherwise unable toconfirm his or her location, control proceeds to step 1036. In step1036, the technologist determines whether the patient requires treatmentbased on a variety of selected factors, which may include the patient'sphysiological data generated by the physiological data devices 30 (thecurrent data and/or historical data) and patient medical history data,which may also be stored for retrieval on the emergency servicesdatabase 62. Step 1036 may also involve consulting with a physician onphysician communication device 36. If no treatment is required, theprocess ends.

If treatment is required, control transfers to step 1044. In step 1044,the technologist selects a treatment facility 31 to which the patientwill be transported by emergency responders. The selection of thetreatment facility may involve querying the treatment facility database90 to identify the most suitable treatment facility 31 based on one ormore criteria selected from the patient's location, the facilityactivation time (i.e., how long it takes for the facility to have therequired services available), the treatment facility location, thetreatment facility equipment and services, and the treatment facilitiescurrent staffing. In step 1046, the technologist uses the call centerphone 56 to dial the emergency services number (e.g., 9-1-1 in theUnited States). Based on the updated ALI record, the selective routingswitch 66 routes the call (and ANI or p-ANI) to the PSAP 40 in the samejurisdiction as the patient's predicted location. PSAP 40 then queriesthe ALI system 48 with the ANI and is provided with the patient'spredicted location on PSAP terminal 44, allowing emergency responders tobe dispatched thereto. When the emergency services call is answered, thetechnologist can inform the PSAP operator of the selected treatmentfacility to which the patient should be taken.

To illustrate the selection of the treatment facility 31, assume thatthe patient has a medical event that is believed to involve the blockageof a coronary artery and that the technologist alone or in consultationwith a physician has determined that a stent is required to relieve theblockage. If the medical event occurs on a Sunday at noon, the cardiaccatheterization lab for the facility in record 92 b of FIG. 3 will beunavailable. However, the cardiac catheterization lab for the facilityin record 92 c will be available. Thus, the technologist would requestthat PSAP 40 direct emergency responders to transport the patient to thefacility specified in field 94 a of record 92 c.

Another exemplary method for using systems 20 or 22 to provide emergencyservices to a patient is described in FIG. 7. Referring to the figure,in step 1048 the technologist receives a preliminary indication of amedical event, which could simply be a communication (phone call, textmessage, e-mail) received from the patient or someone proximate thepatient and/or a message or alarm provided by the emergency servicesserver 60 due to physiological data generated by physiological datadevices 30.

In step 1050, the PSAP associated with the patient's current location isassociated with the ANI for the call center phone 56 in the relevantdatabase associated with selective routing switch 66. The ALI record forcall center phone 56 (or participating PSAP phone 72) is updated so thatits location is the patient's current location. The examples of FIGS. 4and 5 depict exemplary methods of obtaining the patient's currentlocation. In step 1052, the technologist initiates a three-way telephonecall with the patient (using patient communication device 32) and aphysician (using physician communication device 36). To better enablethe physician to assist in diagnosing the patient's potential medicalevent, in step 1054 the technologist causes the patient's physiologicdata to be transmitted from emergency services server 60 to thephysician communication device 36, which in this example would be alaptop, smartphone, or some other device capable of receiving datatransmissions from computer network 34.

In step 1056, the physician and/or technologist determine whether thepatient requires treatment. If the patient does not require treatment,the process ends. If the patient does require treatment, thetechnologist will execute a program on the emergency services server 60to calculate distances between the patient's current location and thelocation of the various treatment facilities (e.g., those specified byrecords 92 a-92 c) in FIG. 3. In step 1060, a list of treatmentfacilities and the distances from the patient to them are displayed onthe technologist terminal 58 along with additional information about thetreatment facilities, such as some or all of the information in fields94 a-94 i of FIG. 3. In step 1062, a treatment facility is selectedbased on one or more criteria selected from activation time, distance(from the patient), services, and schedule. This selection process maybe wholly or partially automated using a program resident executed by aprocessor that is local to the technologist terminal 58 or local to theemergency services server 60.

In step 1064, the technologist uses call center phone 56 (or theparticipating PSAP uses call center phone 72) to dial an emergencyservices number (e.g., 9-1-1 in the United States). In step 1050, theALI database record for the phone 56 is updated to the patient'slocation and the ANI for the call center phone 56 is associated with aPSAP 40 servicing the jurisdiction in which the patient is located.Thus, the call placed in step 1064 is routed with the ANI to the now-associated PSAP 40, which then uses the ANI to query the ALI database 52and obtain the patient's location.

In step 1066, the technologist (or participating PSAP 70 in the case ofa patient using system 22 who is in a jurisdiction serviced by anon-participating PSAP 40), identifies the selected treatment center 31(from step 1062) to the PSAP operator who then dispatches theappropriate emergency responders to the patient's location. In step1068, the technologist contacts the selected treatment facility 31toactivate the services necessary to attend to the patient's medical eventin accordance with the diagnosis developed in step 1054.

In certain cases, the patient location database 80 may indicate that thepatient's most likely location is in transit from one fixed location, asin the example of record 82 a of the patient location database 80. Ifthe patient requires treatment, it may be desirable to have the currenttransfer driver reroute the patient to a selected treatment facility 31.In other cases, it may be desirable to dispatch emergency responders tothe patient's destination to transport him or her to a treatmentfacility 31. One method of providing emergency patient services for apatient who experiences a potential medical event while in transitbetween scheduled appointments is described in FIG. 8. In accordancewith the figure, in step 1068 the technologist receives a time-stampfrom the patient's communication device 32. The time stamp may beassociated with physiological data transmitted to the emergency servicesserver 60. The technologist need not receive the time-stamp directlyfrom the patient, but instead, may receive a stored value of thetime-stamp which is associated (in a database file or a medical datadatabase contained within the emergency services database 62) withphysiological data that caused the emergency services server 60 togenerate an alarm or other message indicating the occurrence of apotential medical event.

In step 1070, a program resident on emergency services server 60 queriesthe patient location database 80 to determine if the time stamp receivedin step 1068 is within a selected time increment (e.g., 15 minutes, 30minutes, 45 minutes, or 1 hour, etc.) of a scheduled transit event(transfer). If it is not, the method of FIG. 5 or another method may beused to obtain a patient location associated with a scheduled orunscheduled event described in the patient location database.

In step 1072, the technologist uses terminal 58 to run a programresident on emergency services server 60 which calculates the drivingpath for the patient's transit event based on initial location and finallocations indicated by the patient location database 80. For example,record 82 a in patient location database 80 defines a transit event fromthe patient's home to a cardiologist's office. Thus, the addresses ofthe patient's home and the cardiologist's office, which would also bestored in the patient location database, are used to calculate adistance between the two locations. In one example, an electronic mapdatabase (e.g. Google maps) is used to calculate the distance.

In step 1074, it is determined whether global positioning orradiolocation coordinates provided by the patient's communication device32 are within a selected distance (e.g., 5 m, 10 m, 20 m, etc.) from thepath defined between the patient's starting and end points. If thecoordinates are not within the selected distance, another method (e.g.,the method of FIG. 5) may be used to determine the patient's location,which may be at a fixed address. If the patient's global positioning orradiolocation coordinates are within the selected distance from thedriving path, control transfers to step 1076, and the driving path andpatient location are displayed on technologist terminal 58.

In step 1078, the technologist determines if treatment is required inthe manner described previously. If no treatment is required, theprocess ends and the patient continues the transit operation to hisscheduled destination. If treatment is required, in step 1080 the ALIdatabase record for the technologist phone 56 is updated to the addressof the patient's destination. Thus, returning to the example of record82 a in FIG. 2, the cardiologist's office address (which may preferablybe an MSAG address) will be used as the new ALI database location forthe phone 56. The SRDB (not shown) will use the updated ALI record toroute the call (and ANI) to the PSAP responsible for the cardiologistoffice's jurisdiction.

In step 1082, a program resident on emergency services server 60 is usedto calculate a distance from the patient's location (as indicated by hisor her global positioning system or radiolocation coordinates) to thedestination and an estimated time of arrival at the destination.

In some cases, a paramedic may have the requisite training and equipmentto treat the patient. In such cases, it may be desirable to have theparamedic meet the patient at the scheduled destination (e.g., thecardiologist's office in the example of record 82 a in FIG. 2). Thus, instep 1084 it is determined whether the paramedic can provide thenecessary'treatment. In certain cases, the determination will be made bythe technologist and in others it will be made by a physician or jointlyby a technologist and physician. If the paramedic can provide thenecessary treatment, the technologist uses technologist phone 56 to dialan emergency services number. Selective routing switch 66 routes thecall to the PSAP 40 responsible for the jurisdiction in which thepatient's destination (e.g., cardiologist's office) is located. The PSAP40 then queries the ALI database 52 to obtain the address, which incertain implementations is an MSAG address. The PSAP 40 then dispatchesa paramedic to the patient's destination.

If the paramedic cannot provide the necessary treatment, controltransfers to step 1086. In step 1086, a treatment facility 31 isselected from the treatment facility 31 database 90 in the mannerdescribed previously. At this point, it may be possible for thepatient's current transit driver to transport the patient to theselected treatment facility 31. Otherwise, it may be desirable todispatch an emergency responder to transport the patient. Thus, in step1088, it is determined whether the patient's current transit driver cantransport him or her to the selected treatment facility 31.

If the patient's current driver can transport him or her to the selectedtreatment facility 31, control transfers to step 1090. In step 1090, aprogram resident on emergency services server 60 calculates the distancefrom the patient's current location (as indicated by global positioningor radiolocation coordinates) to the selected treatment facility 31 andthe estimated time of arrival at the selected treatment facility 31. Ifthe estimated time of arrival at the treatment facility 31 is less than(or no greater than) the estimated time of arrival at the destination(step 1092), the technologist contacts the transit driver (such ascalling him or her with technologist phone 56) and instructs him tore-route the patient to the selected treatment facility 31 (step 1096).

If the estimated time of arrival at the treatment facility 31 is greaterthan (or no less than) the estimated time of arrival at the scheduleddestination (e.g., the cardiologist's office), the technologist usestechnologist phone 56 to dial an emergency services number (step 1094).Selective routing switch 66 routes the call to the PSAP 40 responsiblefor the jurisdiction in which the patient's destination is located. PSAP40 then dispatches emergency responders to the patient's scheduleddestination to transfer him or her to the selected treatment facility31. As indicated by the foregoing, if the patient's transit driver cantransport the patient to the treatment facility 31 more quickly than hecan transport the patient to his destination, he does so. Otherwise,paramedics (who can provide life support during transit) meet thepatient at the scheduled destination and transport him. Accordingly, themethod of FIG. 8 balances the considerations of speed and in-transitlife support to optimize the patient's treatment for the medical eventof concern.

In some instances, none of the scheduled or unscheduled locations ortransit events in the patient location database 80 will be close enoughto the patient's preliminary location (as indicated by globalpositioning or radiolocation coordinates) to reliably indicate thepatient's current location . In such situations, the method of FIG. 5may be modified so that the technologist phone 56 ALI record is updatedto match the patient's preliminary location information. When thetechnologist dials the emergency services number, selective router 66will route the call to the PSAP 40 responsible for the jurisdictionindicated by the patient's preliminary location information. Asindicated above, global positioning coordinates and radiolocationcoordinates typically have an inherent error of +/−300 meters. As aresult, it is preferable to update the technologist phone 56 ALIlocation record based on a geocoded address from patient locationdatabase 80. However, this modified version of the method of FIG. 5 actsas a “fail-safe” when no geocoded address appears to be reliable.

In one further modification, it may be desirable to initiate anemergency services call from the patient's communication device 32 as afail-safe. For example, if there is a failure in the data transfer fromthe emergency services server 60 to the ALI system 48, it may not bepossible to update the ALI database record for the technologist's phone56. Accordingly, in one scenario, the technologist uses technologistterminal 58 to communicate with emergency services server 60 and informserver 60 that an emergency services call will be placed. The server 60transmits instructions to patient communication device 32 which causedevice 32 to place an emergency services call and to initiate athree-way call between the answering PSAP 40 and the technologist phone56. Using standard techniques for the routing of emergency servicescalls from cellular telephones, the patient's call will be routed to thePSAP 40 responsible for the jurisdiction which includes the globalpositioning coordinates and/or radiolocation coordinates of patient'scommunication device 32. The PSAP 40 will then query the ALI system 48for the patient's global positioning or radiolocation coordinates.However, to improve the accuracy of the patient's location, thetechnologist will communicate the patient's geocoded address (e.g., theaddress selected based on the method of FIG. 5) to the PSAP 40 operator.In another variation, the technologist can bypass PSAP 40 and directlycontact a public dispatch access point (PDAP) to dispatch a selectedemergency responder (e.g., ambulance, police, or fire). The technologistcan then communicate the patient's geocoded address to the PDAP. Incertain examples, emergency services database 62 will include one ormore PDAP databases with addresses, phone numbers and other informationrelated to specific PDAPs.

In certain examples, the server farm 61 will include an alarm serverand/or an interpretation server that determines whether physiologicaldata received from physiological data devices 30 indicates a possiblemedical event. The determination of whether a possible medical event isoccurring may be based on the development of patient-specificparameters. In one example, each patient utilizing system 20 or 22 istested to develop a baseline (non-event) condition for the physiologicaldata relevant to his or her condition. Patient-specific criteria may bedeveloped from past medical event occurrences to determine whichdeviations from the baseline condition are most likely to indicate amedical event, and those deviations can be used to trigger an alarmtransmitted to technologist terminal 58. In certain examples, if analarm is generated, both the baseline and alarm-triggering measurementsmay be retrieved from the emergency services server 60 and displayed tothe technologist 58.

In certain embodiments, server 60 is programmed to perform a logisticregression method on geocoded location data. In many cases, atechnologist will be able to verify the patient's actual location anddetermine whether (and how closely) it matches the geocoded locationprovided by the patient location database (e.g. FIG. 2). In certainimplementations, the use of a logistic regression method will allow apercentage accuracy to be displayed to the technologist, which indicatesthe reliability of the geocoded location. In one example, the variablesused to perform the logistic regression include the patient's currentglobal positioning coordinates (or radiolocation coordinates) with atime-stamp and the accuracy radius, the patient's schedule of locations,driving directions (e.g., from a computerized map system such as GoogleMaps), unscheduled locations, verified locations, and unscheduledlocations, such as indicated by credit card bills, checks, planetickets, etc. In one example, the following logistic regression formulaeare used to predict the probability that the geocoded location will becorrect:

f(g)−1=(1|a ^(−z))   (1)

z=β _(a)+β₁x₁+β₂x₂+β₃x₃+ . . . +β_(n)x_(n)  (2 )

where β₀, β₁, . . . β_(n) are the regression coefficients of x₁, x₂, x₃,. . . x_(n), which are the independent variables used to predict thepatient's location .

In certain examples, the logistic regression formula will “learn” byupdating the regression coefficients to improve the accuracy of theprediction.

Systems 20, 22, and 24 as well as the geocoding techniques describedherein can be used in a variety of ways other than providing emergencyservices to patients. For example, systems 20, 22, and 24 could be usedto provide dynamic transportable security systems. In oneimplementation, an alarm system is provided which takes the place ofphysiological data devices 30 and generates an alarm to the call center54 indicating that an intrusion or some other security breach hasoccurred. One known system that is suitable for this purpose is theQuorum A-160 Home Security Monitor. Similar products are also suppliedby ASG Security Systems. Subscribers may have their schedules geocodedin a manner similar to that depicted in FIG. 2 so that when an alarm istriggered, a technologist in the call center 54 receives a geocodedaddress for the subscriber. The geocoded address would then be used toupdate the ALI database 52 based on the geocoded address. When the callcenter phone 56 is used to dial an emergency services number, the callwill be routed to the PSAP 40 servicing the subscriber's location. Inthose systems with enhanced 9-1-1 capability, the PSAP 40 can then querythe ALI system 48 for the subscriber's location and dispatch police,fire, and/or EMS accordingly.

In another implementation, systems 20, 22, and 24 and the geocodingtechniques described herein may be used for search and rescueoperations, including during disasters. For example, a plurality ofsubscribers (instead of patients) may have their schedules geocoded in asubscriber location database included in database 62. The time ofoccurrence of a disaster and its geographic boundaries may be used bythe technologist to determine a list of subscribers who are likelywithin the disaster zone. Their geocoded locations can be used to updatethe ALI record of the call center phone 56 so that the relevant PSAP 40for each of the subscribers may be contacted and dispatched to thegeocoded subscriber locations. The systems 20, 22, 24 could also be usedin a mode whereby when a subscriber does not respond to communications,the call center 54 is alerted and uses the subscriber's geocodedlocation to update the call center phone's ALI record to dispatchemergency responders to the geocoded location. This mode could be usefulfor people engaging in activities such as scuba diving, skiing, hiking,etc. where there is a potential for the subscriber to become injured butunable to dial an emergency services number. In certain modes, a callcenter technologist could make the attempts to contact the subscriberand automatically log failed communication attempts on server 60 so thatan alarm is triggered if a threshold number of failed communicationattempts is exceeded.

In the previous examples, systems 20 and 22 used the triggering of anautomatic alarm generated by sensor data to alert a technologist whothen initiates the querying of a patient (or subscriber) locationdatabase 80 with geocoded locations. However, the system could also beused in a mode in which the patient or subscriber simply calls the callcenter 54 to initiate the process. In one example, if a person islocated in a high rise building in a specific internal location, thetypical MSAG addresses for the building would not be specific enough tofind the person. If the person were to witness a crime or witness/have amedical emergency, he or she could call the call center 54 to initiatethe use of his or her geocoded address to update the call center phone'sALI record, thereby ensuring faster responses by first responders.

The systems and methods disclosed herein may also be usedinternationally and are in no way limited to any one country. Anyonewith a structured schedule can benefit from them. The systems andmethods may also be particularly beneficial for those traveling abroadwho may be unaware of the emergency services number used in the locationof travel. Set forth below are a few non-limiting examples of how thesystems and methods described herein may be used.

EXAMPLE 1

A patient with known cardiac disease requires ECG monitoring and stresstesting to determine whether he suffers from acute coronary syndrome.Instead of admitting the patient to a hospital for the requiredmonitoring and testing, he is discharged and fitted with a 12 leadcontinuous monitoring ECG device, such as the COTTER system supplied byRoss Medical Corporation. The ECG device communicates ECG data to thepatients’ communication device 32, which in turn communicates the datato the emergency services server 60 via computer network 34. Thepatient's schedule of activities, including scheduled stress tests,echocardiograms, and Doctor's office visits is input into the patientlocation database 80 in emergency services database 62. The 12 lead ECGmonitor detects changes that occur in myocardial infarction andischemia, localization of infarcts, right ventricular strain patternscommonly seen in pulmonary embolism, voltage changes seen in pericardialeffusion, arrhythmia analysis, heart axis shifts seen in myocardialinfarction and pulmonary embolism, electrolyte abnormalities such ashyperkalemia, hypokalemia, drug overdoses with substances like digoxinand tricyclic antidepressants, pericarditis, fascicular blocks, andventricular hypertrophy. Using the 12 lead system, a baseline conditionfor the patient is determined and is input into an interpretation serverassociated with server farm 61. When the interpretation serveridentifies an alarm condition, an alarm server associated with serverfarm 61 transmits an alarm to technologist terminal 58 in call center54. The technologist then initiates a query of the patient locationdatabase 80 in the emergency services database 62 to obtain a geocodedlocation for the patient. The ALI database 52 is updated to associatethe geocoded location with the ANI for the call center phone 56. Thetechnologist dials 9-1-1 on the call center phone 56, and the call isrouted to the PSAP 40 based on the updated ALI record. The PSAP usesPSAP phone 40 to query the ALI database 52 and obtain the geocodedlocation. In certain variations, more than 12 ECG leads may be used. Inaddition, instead of a 12 lead ECG device, and implantable cardioverterdefibrillator may be used to measure arrhythmia in a 2 lead system.

In certain implementations, such as those using next generation 911systems, the patient location database 80 or another database that islinked to it may contain additional information that is used todynamically update the ALI record for the call center phone 56. Suchinformation may include floor plans for the building in which thepatient is located, medical information about the patient, and messagesregarding the patient's current condition. Thus, when the PSAP 40receiving the emergency services call queries ALI database 52, PSAP 40will receive the patient's MSAG location, floor plans for the buildingat that location, and medical information about the patient. A messagedescribing the current diagnosis, such as “heart attack” may then bedisplayed to the PSAP operator.

EXAMPLE 2

A patient with congestive heart failure requires fluid status monitoringto detect fluid accumulations which may lead into the lungs. Once thebody fluid volume reaches a certain point, excessive amounts of fluidenter the lungs, reducing gas exchange and increasing breathingdifficulty. Over 3 million people in the US have congestive heartfailure, and 30%-40% of them are hospitalized for fear of such fluidaccumulations. The patient is provided with a blood vessel impedancemonitor to determine fluid status, and his schedule is input in apatient location database 80 of the type described previously. The bloodvessel impedance monitor transmits impedance data to the patient'scommunication device 32, which in turn transmits the data to emergencyservices server 60 via computer network 34. An interpretation server isconfigured to trigger different levels of response, including earlyresponse (pre-symptom), intermediate response, and late response. In theearly response mode, the patient may be contacted by medical respondersor alerted on his or her communication device 32 to ensure that they aretaking their medications and to make any needed medication and dietchanges. In the intermediate response mode, emergency responders aredispatched using system 20 or 22 in the manner described previouslybased on the patient's geocoded location and provide appropriatenon-invasive therapies such as lasix, nitroglycerin, oxygen, etc. In thecritical mode, the patient may require intubation and assistedventilation in an emergency room, and possibly further treatment in anintensive care unit with multiple mediations and potentially invasivemonitoring (i.e., central venous lines). Other physiological datadevices 30 which may be used to monitor congestive heart failurepatients include intra-cardiac pressure sensors, plethysmographysensors, ultrasound, weight scales, and intraarterial pressure sensors.

EXAMPLE 3

A patient with a low oxygen saturation or hypoxia condition, such aschronic obstructive pulmonary disease, restrictive pulmonary disease,asthma, congestive heart failure or any other condition that preventsadequate oxygen saturation is fitted with a pulse oximeter whichtransmits oxygen saturation data to patient communication device 32,which in turn transmits the data to emergency services server 60 viacomputer network 34. An interpretation server that is associated with orincluded in emergency services server 60 is configured to compare thepatient's oxygen saturation data to baseline data and to generate analarm condition based on a specified deviation from the baseline. Thepatient's schedule is entered into a patient location data base 80within or associated with the emergency services server 62. During a lowoxygen saturation condition, an interpretation server compares thebaseline condition to data received from the pulse oximeter anddetermines that an alarm condition exists. An alarm server transmits analarm to the technologist terminal 58 at the call center 54. Based onthe data, and/or in consultation with the patient and/or a physician,the technologist causes the geocoded location from patient locationdatabase 80 to be transmitted to ALI database 52. The technologist dials9-1-1, and the call is routed (with the ANI) to the PSAP 40 responsiblefor the geocoded location. The PSAP 40 queries the ALI system 48 for thepatient's geocoded location based on the ANI. The technologist informsthe answering PSAP 40 that oxygen delivery and medications are requiredto treat the patient, which are available in the dispatched ambulance.In a variation of this example, personnel with prolonged exposure tocarbon monoxide can be provided CO-oximeters to detect carbon monoxidelevels in the blood and to provide emergency services when detectedlevels deviate by a specified amount from a baseline condition.

EXAMPLE 4

Uncontrolled diabetes has many associated acute and chroniccomplications. Self- monitoring blood glucose levels can be difficultfor many patients which can lead to life threatening complications.Patients with continuously elevated blood glucose levels may developdiabetic keto-acidosis, hyperosmolar hyperglycemic non-ketotic coma, andinfections. In this example, a patient is provided with a glucometerthat is configured to transmit glucose data to patient communicationdevice 32 which is in turn configured to transmit the data to emergencyservices server 60 via computer network 34. Certain known glucometersare implantable and/or Bluetooth enabled, such as the Myglucohealth®wireless meter supplied by Entra Health Systems LLC of San Diego, Calif.Baseline glucose data is obtained and saved in a medical record databaseassociated with an interpretation server. The interpretation serverreceives glucose data from the patient and determines whether itdeviates by a specified amount from the baseline data, in which case analarm is transmitted to technologist terminal 58. The patient's scheduleis entered into a patient location database 80. When the interpretationserver detects an alarm condition, the technologist terminal 58 receivesan alarm. The technologist causes emergency services server 60 totransmit the patient's geocoded location to the ALI server 52. Thetechnologist dials 9-1-1, and the call is routed to the PSAP 40 in thepatient's jurisdiction. The PSAP 40 transmits the ANI received with thecall to the ALI system 28 and retrieves an ALI record indicating thepatient's current location, which is displayed on PSAP terminal 44.Emergency responders are dispatched to the patient's location andprovide glucose (in the case of hypoglycemia), and/or other medicationsindicated for the patient's condition. Certain glucometers also measurehemoglobin levels and can be used for this purpose to detect lowhemoglobin (anemia) levels. Low hemoglobin is often the result ofbleeding which can go undetected until hemoglobin levels are dangerouslylow, as in the cases of cirrhosis or peptic ulcer disease. For patientswith low hemoglobin levels but who do not have blood glucose regulatoryproblems, hemoglobin alone can be measured.

EXAMPLE 5

Electroencephalography (EEG) is gaining in popularity in detectingneurological derangements associated with brain cell ischemia duringstroke. Some studies suggest that these derangements precede symptoms.Other studies have correlated specific findings on EEG readings, such asthe presence of delta waves, to areas of the brain that are acutelyischemic. Current research is cost prohibitive because it would requirelong term EEG monitoring in a hospital. In this example, a patient isprovided with an EEG device configured to transmit EEG data to patientcommunication device 32. Baseline data are generated and used togenerate alarms transmitted to technologist 58 in the manner describedpreviously. The alarms may be used to develop algorithms for predictingthe onset of stroke or transient ischemic attack and to dispatch firstresponders to the patient when such an event is imminent. In addition,EEG monitoring can be used to track seizure activity and reduce theneurological damage resulting from such seizures by using the geocodingtechniques described herein to quickly dispatch first responders to thepatient's location.

EXAMPLE 6

Patients who have undergone aortic aneurism repair using endovasculargrafts may need monitoring to ensure that the graphs do not fail.Increased pressure between the walls of the aortic repair may indicaterepair and wall breakdown and could lead to aneurysm rupture, which islife threatening. Monitoring and reducing intravascular pressuresreduces the chance of endovascular graph failure. Thus, in this example,a patient is provided with an endovascular graph pressure sensor whichwirelessly transmits pressure data to the patient communication device32, which in turn transmits the data to emergency services server 60.The patient's schedule is entered into a patient location database 80,and when the sensor indicates a possible medical emergency event (asdetermined by an interpretation server), first responders are dispatchedto the patient's geocoded location by a call center technologist in themanner described previously.

As indicated in the foregoing examples, a number of differentphysiological data devices 32 may be used to monitor a number ofdifferent types of physiological data. Other conditions that could bemonitored include chest pains, shortness of breath, jaw pain, arm pain,leg pain, abdominal pain, diaphoresis, syncope, lightheadedness,swelling, and focal neurological deficits. The following examplesdescribe other scenarios in which systems 20 and 22 and the geocodingtechniques described herein may be beneficially used.

EXAMPLE 7

A number of disaster emergency response subscribers provide scheduleinformation which is input into a subscriber location database similarto the patient location database 80 of FIG. 2. The subscriber locationdatabase is part of or associated with emergency services server 62.During a natural disaster, call center 54 obtains information about thenature of the natural disaster and its geographic boundaries. A serverassociated with server farm 61 is programmed to determine whichsubscribers lie within the geographic boundaries of the affected area.Subscriber communication devices (such as patient communication devices32) comprise smart phones with sensors (e.g., video sensors, speakerphone, pressure sensors, depth sensors, movement sensors, heat sensors,electrical sensors) which can detect and confirm that the subscriber isproximate the communication device. The communication devices providepreliminary location information (e.g., a time-stamp of a transmissionwith GPS coordinates or radiolocation coordinates) to emergency servicesserver 61. Using the preliminary location information, the subscriberlocation database is queried to obtain a geocoded location (e.g., usingthe method of FIG. 5) for the first subscriber believed to be proximatehis or her communication device. The geocoded location is used to updateALI database 52. The technologist dials 9-1-1, and the call is routed tothe PSAP 40 responsible for the geocoded location. The PSAP 40 then usesthe ANI for call center phone 56 to query the ALI database 52 and obtainthe first subscriber's geocoded location, which is then provided to PSAPterminal 58 by selective routing switch 66. Emergency responders arethen dispatched to the subscriber, and the process is repeated for theother subscribers lying within the area affected by the disaster. In onevariant, the time of the disaster is used as a time-stamp to query thesubscriber location database for a geocoded location instead of using atime-stamp received from a subscriber communication device.

EXAMPLE 8

A family subscribes to a home security service that uses the system 20of FIG. 20. The family plans on traveling abroad and provides its travelschedule, which is then entered into a subscriber location databasesimilar to the patient location database 80 of FIG. 2. While abroad, thefamily stays in a rented residence and uses a burglar alarm whichtransmits an alarm to a subscriber communication device (similar topatient communication device 32), which in turn transmits the alarm datato emergency services server 61 along with an associated time-stamp.Alternatively, the alarm device may transmit alarm data to network 34and server 60 without the use of the patient communication device. If atime-stamp cannot be provided, server 60 can use the time of receipt ofthe alarm data for purposes of querying the subscriber locationdatabase. The subscriber location database indicates that the family isin the rented residence. The technologist transmits the geocodedlocation to ALI database 52 to associate the geocoded location with thecall center phone 56. The technologist dials the emergency servicesnumber for the jurisdiction in which the family is staying (e.g., 112 ifthe family is in Spain) and communicates with the local PSAP to obtainassistance for the family. Local law enforcement is then dispatched tothe residence.

EXAMPLE 9

A subscriber is sailing in the ocean, and a storm overtakes his boat.Emergency services server 60 is programmed to receive data concerningnatural disasters in the area in which subscriber is sailing andreceives an alert that one has occurred. The subscriber providesschedule information such as the course and location of his voyage whichis entered in a subscriber location database. A technologist in callcenter 54 is alerted to the storm and queries the emergency servicesserver 60 for the subscriber's geocoded location based on the time-stampof the alert. The geocode algorythm would be similar to the one depictedif FIG. 8 where transit path is used to locate the subscriber. If thetechnologist can reach the subscriber, he contacts the subscriber on thesubscriber communication device 32 to confirm the subscriber's location.Otherwise, the technologist causes emergency services server 60 totransmit the geocoded location to the ALI database 52. The ALI database52 is updated so that the call center phone 56 ANI is associated withthe geocoded location. The technologist dials the emergency servicesnumber for the geocoded location, and the call is routed to the localPSAP 40. The local PSAP 40 queries the ALI system 48 using the ANI andreceives a message identifying the geocoded location on terminal 44. ThePSAP dispatches emergency responders to the geocoded location.

EXAMPLE 10

A subscriber goes scuba diving off the coast of France. Before leaving,he provides his diving schedule which is entered into a subscriberlocation database within or associated with emergency services database62. His diving computer is wirelessly connected to computer network 34and communicates information related to the dive to emergency servicesserver 60. During the dive, the subscriber becomes trapped below thesurface. A low oxygen alarm is triggered by the diving computer and iscommunicated to the emergency services server 60, which in turncommunicates the alarm to call center 54. Based on the time of receiptof the alarm, the technologist queries the subscriber location databaseto obtain the subscriber's geocoded location. The technologist causesemergency services server 60 to transmit the geocoded location (whichmay be a longitude and latitude in this example) to the ALI database 52.The technologist dials the emergency services number for France, and thecall is routed to the PSAP responsible for the geocoded location, whichthen dispatches emergency responders to rescue the diver.

EXAMPLE 11

An attorney works in a high rise office building in a large city. Thebuilding has an MSAG address in its jurisdiction, but none of its floorsor offices have their own distinct MSAG addresses. The attorney provideshis schedule information which includes the internal floors and officesat which he can routinely be found, as well as those at which he mightbe found (e.g., unscheduled locations). The schedule information isentered into a subscriber location database. During a meeting, theattorney's client has a heart attack. The attorney calls the call center54 with his subscriber communication device 32. The technologist usesthe time-stamp of the call to query the subscriber location database.Although he is on the phone, the attorney cannot confirm his internalfloor or office in the building. The ALI database 52 is updated so thatthe call center phone's 56 ANI is associated with the geocoded location,i.e., the building, floor, and office at which the attorney is predictedto be located. The technologist dials 911, and the call is routed to thePSAP 40 in the building's jurisdiction. The PSAP 40 queries the ALIsystem 48 with the ANI and receives the geocoded location, including thebuilding address, floor, and office. Emergency responders are dispatchedto the geocoded location and do not have to guess or use other means toascertain where the attorney and his client are located.

EXAMPLE 12

A subscriber goes on a trip to a relative's home and provides herschedule information which is entered into the subscriber locationdatabase. She also brings with her a portable carbon monoxide and smokedetector which is configured to wirelessly communicate with computernetwork 34, either directly or via subscriber communication device 32. Afire breaks out in the middle of the night, and the subscriber'sdetector generates an alarm which is transmitted to emergency servicesserver 60. A call center technologist receives the alarm and initiates aquery of the subscriber location database to obtain the subscriber'scurrent geocoded location. The technologist attempts to but cannot reachthe subscriber on her communication device 32. The technologisttransmits the geocoded location to the selective routing switch 66 inthe manner described previously and calls 9-1-1. The 9-1-1 call isrouted to the PSAP responsible for the geocoded location, and emergencyresponders are dispatched to the relative's home.

The foregoing examples are meant to be illustrative only. The systemsand methods described herein can be used in a variety of otherapplications, including those in which subscribers or patients aretraveling or mobile and have a defined schedule that can be used togeocode their locations.

1. A system for providing emergency services to a patient with a medicalcondition, comprising: a phone located remotely from the patient; anemergency services server programmed to generate an updated automaticlocation identification database record for the phone based on thepatient's location.
 2. The system of claim 1, wherein the phone is aVoIP phone.
 3. The system of claim 1, wherein the emergency servicesserver is programmed to generate a master street address guide addressfor the patient's location, and the updated automatic locationidentification database record includes the master street address guideaddress.
 4. The system of claim 1, wherein the emergency services serveris programmed to generate an address for the patient's location, theaddress comprises a building street number, a city, and a state, and theupdated automatic location identification database record includes theaddress for the patient's location.
 5. The system of claim 1, whereinthe emergency services server is programmed to determine the patient'slocation based on a patient time-stamp.
 6. The system of claim 5,wherein the emergency services server is programmed to determine thepatient's location by comparing the patient time-stamp to a plurality ofdatabase time entries corresponding to the patient and determiningwhether any of the plurality of database time entries corresponding tothe patient are within a pre-selected time increment from the patienttime-stamp.
 7. The system of claim 5, wherein the patient time-stampcorresponds to one selected from radiolocation coordinates and globalpositioning system coordinates transmitted by a wireless communicationdevice proximate the patient. 5022-0002 PATENT
 8. The system of claim 1,wherein the address further comprises a building number.
 9. The systemof claim 1, wherein the address further comprises a room number.
 10. Thesystem of claim 1, further comprising a patient location databasecomprising a plurality of database time entries and a plurality ofdatabase patient locations, wherein each of the database time entriescorresponds to a patient, and each database patient location correspondsto a database patient time entry.
 11. The system of claim 1, wherein thepatient time stamp is received from the patient or a time at whichmedical data is received from the patient.
 12. The system of claim 1,further comprising a treatment facility database including a pluralityof database treatment facilities, and database treatment facilitylocations, database treatment facility services, and database treatmentfacility schedules corresponding to each of the database treatmentfacilities.
 13. The system of claim 12, wherein the emergency servicesserver is programmed to select a database treatment facility from thetreatment facility database based on at least one selected from thegroup consisting of the patient's location, database treatment facilitylocations, the patient's medical condition, and a time-stamp receivedfrom the patient.
 14. The system of claim 12, wherein the databasetreatment facility services for at least one of the database treatmentfacilities comprises surgical services.
 15. The system of claim 14,wherein the surgical services include cardiac catheterization services.16. The system of claim 12, wherein the database treatment facilityschedule for at least one of the database treatment facilities includesa physician on-call schedule.
 17. The system of claim 12, wherein theemergency services server is programmed to calculate a distance betweena patient location and a database treatment facility location.
 18. Thesystem of claim 1, further comprising a work station comprising adisplay, wherein the display selectively displays one or more databasepatient locations, and when a user selects a displayed database patientlocation, the emergency services server generates an updated automaticlocation identification database record based on the selected databasepatient location.
 19. The system of claim 1, wherein the emergencyservices server is configured to receive medical physiologic data from apatient sensor.
 20. The system of claim 1, wherein the emergencyservices server is programmed to identify the occurrence of a medicalevent based on received medical physiologic data from a patient sensorand reference medical physiologic data, and the system further comprisesa display that selectively displays a message indicating the occurrenceof the medical event.
 21. A system for providing emergency services to apatient with a medical condition, comprising: a phone having anassociated automatic location identification database record, whereinthe automatic location identification database record contains locationinformation for the phone; a patient location database, comprisingdatabase patient identity information for a plurality of patients andone or more database patient locations for each patient from among theplurality of patients; an emergency services server, wherein theemergency services server is programmed to determine a patient locationbased on preliminary patient location information, database patientidentity information, and the one or more database patient locationscorresponding to the patient, and wherein the emergency services servergenerates an updated automatic location identification database recordfor the phone based on the determined patient location or a user-enteredpatient location.
 22. The system of claim 21, wherein the emergencyservices server is programmed to generate a master street address guideaddress for the patient's location, and the updated automatic locationidentification database record includes the master street address guideaddress.
 23. The system of claim 21, wherein the preliminary patientlocation information comprises a time-stamp corresponding to oneselected from radiolocation coordinates and global positioning systemcoordinates transmitted by a patient.
 24. The system of claim 21,wherein the preliminary patient location information comprises atime-stamp corresponding to a time at which medical data is receivedfrom the patient.
 25. The system of claim 21, wherein the patientlocation database comprises a plurality of database time entries, andeach of the one or more database patient locations corresponds to adatabase time entry.
 26. The system of claim 21, wherein the phone islocated remotely from the one or more database patient locations. 27.The system of claim 21, wherein the phone is a VoIP phone.
 28. Thesystem of claim 21, further comprising a treatment facility databaseincluding a plurality of database treatment facilities, and databasetreatment facility locations, database treatment facility services, anddatabase treatment facility schedules corresponding to each of thedatabase treatment facilities.
 29. The system of claim 28, wherein theemergency services server is programmed to select a database treatmentfacility from the treatment facility database based on diagnosticinformation, and a location specified by an updated automatic locationidentification database record.
 30. The system of claim 29, wherein theemergency services server is programmed to calculate a distance betweena location specified by the updated automatic location identificationdatabase record and the location corresponding to the selected treatmentfacility.
 31. The system of claim 21, wherein the patient locationdatabase includes one or more proscribed locations for each patient. 32.The system of claim 21, wherein the emergency services server isprogrammed to identify the occurrence of a medical event based onreceived medical physiologic data transmitted by a patient and referencemedical physiologic data, and the system further comprises a displaythat selectively displays a message indicating the occurrence of themedical event.
 33. The system of claim 32, wherein the medical event isone or more selected from acute coronary syndrome, myocardial ischemia,myocardial infarction, cardiac arrhythmia, syncope, congestive heartfailure, pulmonary edema, stroke, transient ischemic attack, elevatedintracranial pressure, seizure, and carbon monoxide poisoning.,
 34. Thesystem of claim 32, wherein the medical physiologic data comprises atleast one selected from ECG data, implantable cardioverter defibrillatordata, blood vessel impedance data, intra-cardiac pressure sensor data,ultrasound data, intracranial pressure sensor data, pulse oximetry data,co-oximeter sensor data, light absorbance data, glucometer data, EEGdata, and endovascular graph sensor data.
 35. The system of claim 21,wherein the emergency services server is programmed to calculate apercent accuracy for the determined patient location based on aplurality of previously determined patient locations and a plurality ofcorresponding confirmed patient locations.
 36. The system of claim 21,wherein the emergency services server is programmed to determine atleast one of a distance and a transit time between the patient and atransfer destination.
 37. The system of claim 21, wherein the emergencyservices server is configured to receive patient identity informationand corresponding coordinates for a plurality of patients, and thecoordinates are selected from the group consisting of radiolocationcoordinates and global positioning system coordinates.
 38. The system ofclaim 21, further comprising a mobile wireless communication deviceconfigured to transmit patient identity information to the emergencyservices server.
 39. The system of claim 38, further comprising at leastone medical diagnostic device configured to transmit medical physiologicdata to the mobile wireless communication device.
 40. The system ofclaim 21, wherein the preliminary patient location information comprisesa patient time-stamp, the patient location database comprises one ormore database time entries each corresponding to a database patientlocation, and if the patient time-stamp is within a pre-selected timeincrement from one or more of the patient's database time entries, thedetermined patient location is set to a database patient location thatcorresponds to one of the patient's one or more database time entries.41. The system of claim 40, wherein the pre-selected time increment isabout 45 minutes.
 42. The system of claim 40, further comprising a userdisplay, wherein the patient's database time entries and correspondingdatabase patient locations are selectively shown on the display.
 43. Thesystem of claim 42, wherein when a user selects one of the displayeddatabase patient locations, the server generates an updated an updatedautomatic location identification database record for the phone whichcorresponds to the selected displayed location.
 44. The system of claim21, wherein the preliminary patient location information comprises apatient time-stamp, the patient location database comprises one or moredatabase time entries each corresponding to a scheduled transfer of thepatient to a database destination location, and the determined patientlocation is set to a database destination location that corresponds toone of the patient's database time entries which is within apre-selected time increment from the patient time-stamp.
 45. The systemof claim 21, wherein when a designated emergency services phone numberis entered into the phone, a call is placed to a public safety accesspoint corresponding to the location defined by the updated automaticlocation identification database record.
 46. A method of providingimproved emergency services, comprising: receiving a patient's medicalphysiologic data indicating the occurrence of a medical event;determining the patient's location; and updating an automatic locationidentification database record for a phone based on the patient'slocation, wherein the phone is located remotely from the patient'slocation.
 47. The method of claim 46, further comprising entering apredetermined emergency services number into the phone, thereby placinga call to a public safety access point corresponding to the updatedautomatic location identification database record.
 48. The method ofclaim 46, wherein the phone is a VoIP phone.
 49. The method of claim 46,wherein the step of updating an automatic location identificationdatabase record for a phone based on the patient's location comprisesdetermining a master street address guide address for the patient'slocation.
 50. The method of claim 46, further comprising contacting thepatient to confirm the patient's actual location
 51. The method of claim46, wherein the step of determining the patient's location comprisesdetermining the patient's location based on a patient time-stampcorresponding to one selected from radiolocation coordinates and globalpositioning system coordinates.
 52. The method of claim 51, wherein thestep of determining the patient's location comprises determining if thepatient's time-stamp is within a pre-selected time increment from adatabase time entry corresponding to the patient.
 53. The method ofclaim 46, wherein the step of determining the patient's locationcomprises determining the patient's location based on a patienttime-stamp corresponding to a time at which medical data is receivedfrom the patient.
 54. The method of claim 46, further comprisingselecting a treatment facility based on at least one selected from thegroup consisting of the patient's location, facility locationinformation, the patient's medical condition, and a time stampcorresponding to one selected from radiolocation coordinates and globalpositioning system coordinates.
 55. The method of claim 54, wherein thestep of selecting a treatment facility comprises accessing a treatmentfacility database, and the treatment facility database comprises aplurality of database treatment facilities, and database treatmentfacility locations, database treatment facility services, and databasetreatment facility schedules corresponding to each of the databasetreatment facilities.
 56. The method of claim 54, wherein the step ofselecting a treatment facility comprises calculating a distance from thepatient's location to the treatment facility locations for a pluralityof treatment facilities in the treatment facility database.
 57. Themethod of claim 46, further comprising calculating a predicted accuracyfor the step of determining the patient's location.
 58. The method ofclaim 46, further comprising comparing the patient's received medicalphysiologic data and comparing it to reference medical physiologic datato determine the occurrence of the medical event.
 59. A method ofdetermining a patient's location, comprising: providing a patienttime-stamp; providing a schedule of patient activities, the schedulecomprising a plurality of scheduled times, each scheduled timecorresponding to a scheduled location, and each scheduled locationcomprising a master street address guide location; receiving apreliminary location for the patient; and selecting a scheduled locationbased on the time-stamp and the preliminary location.
 60. The method ofclaim 59, wherein the step of selecting a scheduled location based onthe time-stamp and the preliminary location comprises selecting a firstscheduled time, the first scheduled time is within a selected timeincrement from the time-stamp, and the first scheduled time correspondsto a first scheduled location.
 61. The method of claim 60, wherein thefirst scheduled location is within a selected distance from thepreliminary location.
 62. The method of claim 60, wherein the selecteddistance is no greater than about 600 meters.
 63. The method of claim60, wherein the step of selecting a scheduled location based on thepatient time-stamp and the preliminary location further comprisesselecting a second scheduled time, the second scheduled time is withinthe selected time increment from the patient time- stamp, and the secondscheduled time corresponds to a second scheduled location.
 64. Themethod of claim 59, further comprising determining at least oneprobability that the patient is at the scheduled location based on atleast the patient time-stamp and the preliminary location.
 65. Themethod of claim 64, wherein the step of determining at least oneprobability that the patient is at the scheduled location comprisesdetermining a plurality of probabilities that the patient is at thescheduled location, wherein each probability corresponds to a distancebetween the preliminary location and the scheduled location.
 66. Themethod of claim 59, wherein the step of providing a patient time-stampcomprises receiving a time-stamp transmitted by a wireless communicationdevice proximate the patient.
 67. The method of claim 59, wherein thestep of providing a patient time-stamp comprises determining a time atwhich medical data is received from the patient.
 68. A method ofproviding emergency services to a patient comprising: determining thepatient's location in accordance with the method of claim 59; anddispatching a medical services provider to the selected scheduledlocation.
 69. The method of claim 68, wherein the step of dispatching amedical services provider to the selected scheduled location comprisesupdating an automatic location identification record for a phone basedon the selected scheduled location, and the phone is remotely locatedfrom the patient.
 70. The method of claim 69, wherein the step ofdispatching a medical services provider to the selected scheduledlocation comprises entering an emergency services phone number into thephone such that a call is placed to a public safety access pointcorresponding to the location defined by the updated automatic locationidentification database record.
 71. The method of claim 68, furthercomprising selecting a treatment facility based on at least one selectedfrom the group consisting of the selected scheduled location, facilitylocation, the patient's medical condition, and the patient time-stamp.72. The method of claim 71, wherein the step of selecting a treatmentfacility comprises calculating a distance between the selected scheduledlocation and the facility location.